Behavioral health experts identify concerns with CARE Court program

A pair of speakers at the 2022 Los Angeles State of Reform Health Policy Conference identified some challenges they are expecting with implementation of the recently established CARE Court system. The panelists also discussed how they expect the CARE Courts to impact the state’s behavioral health system.

 

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The CARE Court program, established through Senate Bill 1338, aims to provide treatment, housing, and support services to Californians with complex behavioral health needs. The program provides these individuals with court-ordered care plans that last up to 12 months with the option to be extended, and focuses on individuals on the schizophrenia spectrum or with other psychotic disorders. 

Individuals can be referred to the program via a petition to the court from care providers, family members, or other specified individuals. Participants of the program are required to comply with the court order and engage with all court proceedings.

Connie Draxler, Acting Chief Deputy Director at the Los Angeles County Department of Mental Health, said the LA County Department of Mental Health expects many more individuals to be eligible for CARE Court than the state originally estimated. 

According to Draxler, the state estimates about 7,000 to 12,000 clients statewide to be eligible, with about 2,500 to 4,000 potential participants in LA County. However, a UCLA study on the population of people experiencing homelessness in LA County alone revealed that 10% of this population fell into this eligibility category (about 4,500 people). 

Draxler said this number didn’t account for justice-involved individuals who may be eligible, as well as other populations of individuals that may be eligible. 

“There are elements in the diversion statutes that will allow the court to refer directly to CARE Court for anyone who’s considered for diversion, and it does not at all take into consideration the family members who are supporting their loved ones who may want to file a petition in the CARE Court,” she said. “So we’re thinking the numbers are higher, and with those numbers, we anticipated that there would be an increased strain on the system.”

She added that many of the individuals coming to the LA County Department of Mental Health through CARE Court will have not already been involved in the system. 

“Maybe we have engagement with them [through] our homeless outreach teams, maybe they chose not to participate in services,” she said. “One of the arguments we’ve heard is that ‘This is your population anyway, just work with it.’ I think it’s our population in terms of diagnosis, but I’m just not sure that it’s clients we’ve already been touching.”

Draxler said they are anticipating that the influx of CARE Court clients will stress an already stressed system and raises concerns about limited resources. 

“We’re probably going to be asked to redirect services because the legislation was really making it clear that CARE Court participants should be prioritized in our system. I think from a county mental health or rural health perspective, there is concern about whether or not we will have to redirect services or be more picky about how we select our services and where our dollars are invested because we have to prioritize.”

She added that many of the court processes required with CARE Courts, like court-ordered assessments, are not eligible for reimbursement under Medi-Cal, as the money that has been placed in appropriations is primarily related to the court implementation of this process and not related to service delivery.

Karen Vicari, Interim Public Policy Director at Mental Health America of California, said she is also concerned that the bill establishing the CARE Courts does not put additional money into service delivery and does not mandate housing for CARE Court participants either.

Vicari said the involuntary treatment aspect of the CARE Courts is also a cause for concern.

“From a peer perspective, recovery of a mental health condition is a self-directed, nonlinear process,” she said. “When you have an involuntary treatment order, and make [them] take medications [and get] services, that does not create long-term change. It costs a lot more and it takes longer, but we really believe that if we can adequately fund community-based mental health services [that are] culturally responsive, [and] where people feel comfortable going, that’s really where we should be investing our money and our energies.”